How to improve your technique

As I have said before, it’s difficult for us to sometimes identify where our weak spots are because we cannot directly observe ourselves in a normal 2-way consultation.

But there are other ways of getting a third eye to focus on ourselves – and that is through either videoing ourselves and/or getting feedback from other observers (like trainers, colleagues, patients and so on).

In terms of repeated practise – no point just reading through skills and memorising them from consultation/communication books. You have to practise them again and again – just like you did when tying your shoe laces as a child – you practised until it became effortless. And so, for the CSA, you must do the same.

Want to feel like this?

In the beginning... focus on the story & ditch the timer

You have 10 minutes per case in the CSA. But if you are just starting off, you should not worry about that. So, if you’re starting out on your CSA practice, forget having a timer (by the way, you should be start preparing for you CSA at least 6 months before the exam date). At this stage it is important that you focus on

developing your consultation framework

learning how to follow the story (the patient’s narrative)

taking a good enough history and examination

improving your explanations and

learning how to formulate a joint management plan.

Later on, say 3 months before the exam, your consultation skills should be good enough. It is at this 3-month-before-the-CSA-date that you can start getting the timer out and trying to do it all in 10 minutes. And practice twice a week.

CSA Practice Methods

Here are some methods to help you identify your weak spots and repeatedly practise new skills.

Attend Mock CSA sessions

All GP training schemes up and down the country run s either at HDR or externally.

In fact, some Deaneries put on special mock CSAs throughout the year (like Yorkshire & the Humber do).

Make sure you don’t miss out on these invaluable practise opportunities.

Practise in a variety of ways with your GP Trainer

Ask your trainer to do some role playing CSA sessions with you.

Also also them to look at your consultation videos not just through COT but ask them how you would have done in the CSA – ask them to grade according to the three CSA domains – Data Gathering, Clinical Management, Interpersonal Skills.

And of course, practise with your trainer through doing Sit and Swap surgeries (ask your trainer if you don’t know what these are).

See lots of real patients in real surgeries

This is incredibly important.

The biggest training session you have in your daily working life is normal surgery consultations with real patients.

Many GP trainees will book weeks off to ‘study’ for the CSA – when actually, it’s the practise that is important. And what better way to practice your consultation and clinical skills than with real patients who present with a wide variety of things.

If you get stuck with a patient – if it’s a clinical thing – look it up. If it’s a consultation skills thing – talk to your trainer.

By reflecting on your behaviour, your approach, your clinical knowledge and the way you say things with real patients is the most effective and effortless way of learning and preparing for the CSA exam. Much better than books!

The CSA is meant to mimic a real surgery. The types of patients and cases that you see by doing lots of GP surgeries are often the type of things that come up in the CSA exam. And this are the types of things you are expected to know!

Sit in with your GP trainer and observe

This will open your eyes to alternative approaches, wordings and skills.

Sit in with other doctors and other health professionals

Like the nurses and health visitors – observe how they do things like asthma reviews and baby checks.

Video yourself

VIDEO YOURSELF – not just for COTs.

Video your own surgeries (with consent of course). And then watch them by yourself – you don’t always have to use a trainer or TPD. You’re an adult learner and you should be able to educate yourself.

Video the role plays in your CSA study group – suggest it to them. You/They might not like it at first, but it is an incredibly powerful tool that can help you pass. By the end, you will love video work (or something closer towards love!).

Like I said before, video provides that vital third external diagnostic eye that you can turn towards and reflect on yourself. It makes you aware of things you say and do which you would not be aware of otherwise. Sometimes what we think we have said or behaved is far from what actually was said or done. Video is the thing that will open your eyes.

So video your surgeries and video your role plays in the CSA study groups. Watch some together with your trainer, TPD and trainees and watch some on your own.

Dr Rahman gives some good advice on getting feedback from others

Respect your trainer and they will help you more

Please leave a comment below if you have any words of wisdom to help others or if you have any questions you wish to ask…

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